Coronavirus: Which painkiller should I take?

Paracetamol, codeine or ibuprofen? Doctor Sophie Shotter advises us which pain relief to take for which type of ailment from period cramps to COVID-19

Painkillers are flying off the shelves at the moment, but there's still a degree of confusion over which ones to use for different ailments - specifically for coronavirus. To clear things up, we asked Dr Sophie Shotter, Medical Director of Illuminate Skin Clinic who is currently running a non-profit private GP service in the time of coronavirus, with both remote and in-person appointments.

Ibuprofen: when to take it and when not to?

You may have read reports that taking ibuprofen for coronavirus is ill-advised. As Sophie explains, this originates from doctors in France noticing a link between young people diagnosed with COVID-19 people becoming very ill after taking the ibuprofen. This is not scientifically accurate, at this stage, says Sophie and the World Health Organisation has withdrawn its advice on avoiding the anti-inflammatory drug, which includes Nurofen, for coronavirus symptoms. "Having said that, right now if I got COVID-19, I wouldn't take Ibuprofen, I would stick to paracetamol," she says.

That approach is also recommended by the NHS website, which states: "There is currently no strong evidence that non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen can make coronavirus (COVID-19) worse. But until we have more information, take paracetamol to treat the symptoms of coronavirus, unless your doctor has told you paracetamol is not suitable for you"

What if you take ibuprofen for other things anyway? "If you have no coronavirus symptoms and regularly take ibuprofen for pain relief, carry on taking it as usual. If you develop coronavirus symptoms, ask your doctor about changing to paracetamol instead," advises the NHS.

What does Sophie take ibuprofen for herself? "If I've got period pain, joint pain or backache I often reach for my ibuprofen because it's anti-inflammatory and will really help to calm any pain caused by inflammation."

Paracetamol: best for coronavirus, colds and flu

"Paracetamol is our best friend, it's a great painkiller and very effective and pretty safe to take for most people," says Dr Sophie. She advises taking paracetamol for coronavirus because it's "brilliant at controlling your temperature - and high temperatures are one of the symptoms." Adults should take two tablets every four hours, she advises. For children, the dosage depends on their weight.

She personally takes paracetamol for colds and flu; her choice is Night- and Day Nurse. "Be careful as they have paracetamol in them, so don't take those plus paracetamol tablets."

Some paracetamol tablets contain caffeine. "Caffeine can help increase the effect of some painkillers by five to ten per cent, so can be a useful addition."

Paracetamol and alcohol

"Exercise taking it with caution with alcohol," she reminds us. "That's not to say that if you've got a hangover headache don't take paracetamol because by the morning a lot of the alcohol is through your system." But both paracetamol and alcohol rely on the same liver enzyme pathways to be metabolised, she adds, so avoid overloading your liver. In short: "Take paracetamol for a hangover, but not too much of it."

When to take codeine

"Codeine is a member of the opioid family, which means it's related to morphine and it's actually turned into morphine in your body which is how it has its pain-relieving effect. It's a very good pain reliever if you need it but it can have some side effects," she warns, citing nausea and constipation as side effects of codeine.

Be careful about taking it with other opiate painkillers such as dihydrocodeine or tramodol, she adds. "If you are on any other opiates, stick to just the one in order to be careful not to overdose."

What does Sophie take codeine for? "If I have a really pounding migraine, I will reach for some codeine, but I will have tried the other painkillers first."

Aspirin as a painkiller?

This gets the thumbs down from Dr Sophie. She told us subsequently that she didn't rate aspirin as a painkiller, "although it's great for heart attacks and strokes." People at high risk of these, or who have had one may be advised to take low-dose of aspirin, by their doctor, according to the NHS website. The NHS does however list is as a useful painkiller for conditions such as headaches and toothache, cold and flu. You can read the NHS guidance on aspirin here.

Dr Sophie Shotter is a former A&E doctor and now Medical Director at Illuminate Skin Clinic and practices in London and Kent.

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